Archive for category cognitive

Abstract

Background. Cognitive deficits are among the most disabling consequences of traumatic brain injury (TBI), leading to long-term outcomes and interfering with the individual’s recovery. One of the most effective ways to reduce the impact of cognitive disturbance in everyday life is cognitive rehabilitation, which is based on the principles of brain neuroplasticity and restoration. Although there are many studies in the literature focusing on the effectiveness of cognitive interventions in reducing cognitive deficits following TBI, only a few of them focus on neural modifications induced by cognitive treatment. The use of neuroimaging or neurophysiological measures to evaluate brain changes induced by cognitive rehabilitation may have relevant clinical implications, since they could add individualized elements to cognitive assessment. Nevertheless, there are no review studies in the literature investigating neuroplastic changes induced by cognitive training in TBI individuals.

Objective. Due to lack of data, the goal of this article is to review what is currently known on the cerebral modifications following rehabilitation programs in chronic TBI.

Methods. Studies investigating both the functional and structural neural modifications induced by cognitive training in TBI subjects were identified from the results of database searches. Forty-five published articles were initially selected. Of these, 34 were excluded because they did not meet the inclusion criteria.

Results. Eleven studies were found that focused solely on the functional and neurophysiological changes induced by cognitive rehabilitation.

Conclusions. Outcomes showed that cerebral activation may be significantly modified by cognitive rehabilitation, in spite of the severity of the injury.

MRI scans show that people diagnosed with OCD who have undergone CBT have intensified connectivity between key brain networks.

Researchers have used brain scans to measure changes in the cerebral activity of people with obsessive-compulsive disorder after undergoing a type of cognitive behavioral therapy. They found that the connectivity of key brain networks is improved, suggesting new targets for therapy.

OCD can be a debilitating condition and can severely impair daily functioning. The National Institutes of Mental Health estimate that, in the United States, the yearly prevalence of OCD amounts to 1 percent of the total adult population. Around half of these cases are deemed “severe.”

Treatments for OCD include the administration of selective serotonin reuptake inhibitors and cognitive behavioral therapy (CBT), a type of therapy that aims to improve damaging mind associations.

Researchers from the University of California, Los Angeles – who were led by Dr. Jamie Feusner – have conducted a study aiming to find out whether and how CBT might change levels of activity and network connectivity in the brains of people diagnosed with OCD.

They explain that although the efficacy of CBT in treating OCD has been previously explored, this is likely the first study to use functional MRI (fMRI) to monitor what actually happens in the brains of people with OCD after exposure to this kind of therapy.

The researchers’ findings were recently published in the journal Translational Psychiatry.

Changes in key brain regions following CBT

The team specifically targeted the effects of exposure and response prevention (ERP)-based CBT, which entails exposure to triggering stimuli and encouraging the individual to wilfully resist responding to those stimuli in the way that they normally would.

For the study, 43 people with OCD and 24 people without it were recruited. The results for the two groups were later compared, at which point the 24 individuals without OCD were taken as the control group.

All the participants diagnosed with OCD received intensive ERP-based CBT on an individual basis in 90-minute sessions on 5 days per week, for a total of 4 weeks.

Participants from both groups underwent fMRI. Those diagnosed with OCD, who had received CBT, were scanned both before the treatment period and after the 4 weeks of treatment. Participants from the control group, who did not undergo CBT, also had fMRI scans after 4 weeks.

When the scans of participants with OCD were compared, the results from before exposure to CBT and after it were found to be largely contrasting.

The researchers noticed that the brains of people with OCD exhibited a significant increase in connectivity between eight different brain networks, including the cerebellum, the caudate nucleus and putamen, and the dorsolateral and ventrolateral prefrontal cortices.

The cerebellum is involved with processing information and determining voluntary movements, while the caudate nucleus and putamen are key in learning processes and controlling involuntary impulses.

The dorsolateral and ventrolateral prefrontal cortices are involved with planning action and movement, as well as regulating certain cognitive processes.

Dr. Feusner and team point out that an increased level of connectivity between these cerebral regions suggests that the brains of the people who underwent CBT were “learning” new non-compulsive behaviors and activating different thought patterns.

He suggests that these changes may be novel ways of coping with the cognitive and behavioral idiosyncrasies of OCD.

“The changes appeared to compensate for, rather than correct, underlying brain dysfunction. The findings open the door for future research, new treatment targets, and new approaches.”

Dr. Jamie Feusner

First study author Dr. Teena Moody adds that being able to show that there are quantifiable positive changes in the brain following CBT may give people diagnosed with OCD more confidence in following suitable treatments.

“The results could give hope and encouragement to OCD patients,” says Dr. Moody, “showing them that CBT results in measurable changes in the brain that correlate with reduced symptoms.”

ABSTRACT

Background: Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance.

Objective: The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression.

Methods: This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward.

Results: A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings.

Conclusions: In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement.

Introduction

Depressive disorders are among the most common and serious mental illnesses [1]. Globally, 350 million people of all ages are estimated to suffer from depression. If depressive disorders are detected at an early stage, they are highly treatable in the majority of cases [2]. There are known effective psychological treatments, for example, cognitive behavioral therapy (CBT) [3]. However, individuals suffering from depression often find themselves confronted with barriers to receiving appropriate care such as social stigma associated with mental disorders, long waiting times, or the logistical difficulties of appearing in person for treatment [4,5]. For these reasons, computerized programs present an innovative approach to improving access to psychological treatments for depression. There is evidence that computerized cognitive behavioral therapy (cCBT) is effective in the treatment of various mental disorders, including depression [6–10]. There are a number of advantages that are associated with cCBT such as anonymity, wide availability, or location-independent and around-the-clock access [9,11]. Well-known cCBT programs such as Beating The Blues and MoodGYM have been shown to provide a promising option for the treatment of mental health problems [9,12,13]. A prerequisite for cCBT programs to be effective is its user acceptance, as the implementation of an innovative intervention such as cCBT can be affected negatively because of individuals being unwilling to use it. For example, the absence of a contact person and the resulting anonymity can have a negative impact on the user’s motivation to start or keep up with a cCBT program. Therefore, it is of utmost importance to consider user acceptance when developing and implementing a cCBT program for the treatment of depression.

The concept of user acceptance arose as a key term in the scientific discourse. Definitions of the term differ widely depending on the intended use [14]. One of the most popular approaches is the technology acceptance model (TAM) developed by Davis [15]. TAM illustrates user acceptance determined by two factors: perceived usefulness and perceived ease of use. According to Davis [15], both have a significant impact on a person’s attitude toward using a new technology. Kollmann [16] and Rogers [17] went one step further and combined different phases in their acceptance models. Therefore, the user passes through phases from getting to know a new technology, to forming an attitude toward it, to a decision whether to use or not to the confirmation of the decision. On this basis, user acceptance can be defined as the willingness of individuals to employ information technology for the tasks it is designed to support, the realization, and approval of the decision to employ. All of these models have one thing in common: user acceptance is considered to be a process beginning with an attitude toward the innovation and developing into satisfaction with the innovation; it is not an instantaneous act. Accordingly, we have conceived acceptance as the act of accepting, experiencing, and being satisfied.

Since the emergence of the first cCBT programs, there have been a number of reviews addressing the user acceptance of cCBT; however, they have utilized different approaches. In their reviews, Titov [18], Andrews et al [8], and Vallury et al [19] focused broadly on effectiveness and user acceptance of cCBT for several mental disorders, including depression and anxiety disorders. Waller and Gilbody [20] reviewed quantitative and qualitative studies examining adverse consequences, accessibility, and acceptability of cCBT programs for treating anxiety and depression. However, Kaltenthaler et al [21] provide the only review with a very comprehensive and focused insight into the user acceptance of cCBT for depression, including research up to June 2007. They systematically reviewed sources of information on acceptability to patients of cCBT for depression. As a result, they documented several studies reporting positive expectancies and high satisfaction in routine care cCBT services for those completing the treatment and argued that studies should reveal more detailed information on patient recruitment methods, dropout rates, and reasons for dropping out. Furthermore, they drafted well-designed surveys and qualitative studies included alongside trials to determine levels of patient acceptability as implications for further research.

On this basis, we provide a systematic overview on user acceptance of cCBT for depression over the last 10 years and widen the perspective to include the notion that the process of user acceptance spans a number of phases, including accepting, experiencing, and being satisfied with cCBT. We intend to answer the following research questions: (1) which measures were used to examine the user acceptance of cCBT for depression? and (2) to what degree do users accept cCBT for depression? […]

Physical and cognitive rehabilitation is usually a challenging activity as people with any kind of deficit has to carry out tasks difficult due to their abilities damaged. Moreover, such difficulties become even harder while they have to work at home in an isolated manner. Therefore, the development of collaborative rehabilitation systems emerges as one of the best alternatives to mitigate such isolation and turn a difficult task into a challenging and stimulating one. As any other collaborative system, the need of being aware of other participants (their actions, locations, status, etc.) is paramount to achieve a proper collaborative experience. This awareness should be provided by using those feedback stimuli more appropriate according to the physical and cognitive abilities of the patients. This has led us to define an awareness interpretation for collaborative cognitive and physical systems. This has been defined by extending an existing proposal that has been already applied to the collaborative games field. Furthermore, in order to put this interpretation into practice, a case study based on an association image-writing rehabilitation pattern is presented illustrating how this cognitive rehabilitation task has been extended with collaborative features and enriched
with awareness information

Virtual reality (VR) has seen a rise in use by the healthcare industry. From teaching medical students about trauma procedures, to helping tackle the loneliness and isolation of long-term medical care, VR has seen a variety of uses in medicine. Now Samsung are aiming to develop VR system that can help in the field of mental health.

Mental health care is a complex field, with many of the mechanisms surrounding mental health conditions still poorly understood. Working with VR content creator FNI and the Gangnam Severence Hospital in South Korea, Samsung hopes to gain some insight into this area, and make advances in the field of mental health care.

The project will be aimed at developing systems in the areas of cognitive behaviour therapy, suicide prevention and psychological assessment. A combination of the Samsung Gear VR headset, Gear S3 smartwatch, S Health app and AI virtual assistant Bixby will be used to develop diagnosis kits and other physical products and applications. Medical data from the hospital will be used to ‘teach’ the AI about the medical conditions it will encounter.

The three companies are hoping to be able to turn the products into a commercial product that can be rolled out to hospitals, dementia centres and schools at some point in 2018. There are also plans to make the products available to patients for home use at some point.

VRFocus will bring you further information on Samsung’s VR health applications as it becomes available.

Abstract

We investigated differences in brain activation associated with cognitive fatigue between persons with traumatic brain injury (TBI) and healthy controls (HCs). Twenty-two participants with moderate-severe TBI and 20 HCs performed four blocks of a difficult working memory task and four blocks of a control task during fMRI imaging. Cognitive fatigue, assessed before and after each block, was used as a covariate to assess fatigue-related brain activation. The TBI group reported more fatigue than the HCs, though their performance was comparable. Regarding brain activation, the TBI group showed a Task X Fatigue interaction in the caudate tail resulting from a positive correlation between fatigue and brain activation for the difficult task and a negative relationship for the control task. The HC group showed the same Task X Fatigue interaction in the caudate head. Because we had prior hypotheses about the caudate, we performed a confirmatory analysis of a separate dataset in which the same subjects performed a processing speed task. A relationship between Fatigue and brain activation was evident in the caudate for this task as well. These results underscore the importance of the caudate nucleus in relation to cognitive fatigue.

The interaction of Group, Task and Fatigue in Experiment 1 in the caudate head (indicated by blue arrow). The plots on the left are included only to show the slopes of the regression lines. For the HC group, there was a negative correlation between fatigue and activation for the 0-back task (top left), and a positive correlation for the 2-back task (top right). For the TBI group, the correlations between fatigue and activation in both tasks were very weak (lower plots). In all cases, the vertical axis is the percent signal change in the caudate head and the horizontal axis is the normalized fatigue score. On the right is a 3-dimensional rendering of the activation in the caudate head for Experiment 1.

Individuals with neurological damage often report difficulties with cognitive fatigue, a subjective lack of mental energy that is perceived to interfere with daily activities. Because of poor correlation between self-reports of cognitive fatigue and tests of cognitive performance, scientists are looking at more objective measures, such as correlations with neuroimaging findings. In the Kessler study, brain activation patterns were compared in 22 individuals with moderate to severe TBI and 20 healthy controls. Both groups performed tasks of working memory during functional MRI imaging of the brain; the TBI group reported more fatigue, although performance was comparable between the groups. The results showed that the experience of self-reported fatigue is associated with activation changes in the caudate nucleus of the basal ganglia.

“These results are consistent with findings in our related research in the multiple sclerosis (MS) population,” said Dr. Wylie, the lead author, “which suggests that the TBI and MS populations share a mechanism for cognitive fatigue.” This has important implications for the development of effective treatments. “This study points to the caudate nucleus as a likely target for clinical interventions to alleviate fatigue,” explained Dr. Wylie, who is associate director of Neuroscience Research and the Rocco Ortenzio Neuroimaging Center at Kessler Foundation.

Story Source:

Materials provided by Kessler Foundation. Note: Content may be edited for style and length.

Why does stress bring back my TBI symptoms with a vengeance? It feels like a knife reopening a wound. What goes wrong in the brain after injury that makes this happen?

Answer:

Stress occurs when there is a gap between the current task demands and the resources you have to meet those demands. Your brain interprets this as a threat. Acute stress — as in immediate physical danger — produces a physical reaction (the fight-or-flight response) that includes increased pupil dilation, perspiration, increased heart rate and blood pressure, rapid breathing, muscle tension, and increased mental alertness. However, less immediately threatening or prolonged stressors, such as ongoing money problems, too many things to get done in one day, even something like unexpected company, will produce these reactions. They may occur to a lessor degree, but ongoing stress reactions, even mild ones, will result in your body preparing for a long-term protective response.

Fatigue, concentration lapses, irritability, and lethargy result as the stress continues without relief. You probably recognize these as some of the TBI symptoms you feel coming back with a vengeance. Having experienced a TBI makes you both more susceptible to these symptoms, and these symptoms make it more difficult for you to effectively use whatever coping or compensatory strategies you may have developed to manage your TBI symptoms.

Learning to manage stress is important for all of us, and of particular importance to the recovery process after TBI. Techniques such as relaxation, time management, goal-setting, organization, cognitive-behavioral techniques, and lifestyle modifications can all be helpful in managing stress. It is recommended that you get some help and support in figuring out which of these techniques will be most useful for you from a mental health provider, a case manager, a life coach, a support group, or even a good friend if the stress levels are not overwhelming or seriously affecting your life. There are plenty of resources available for stress management, and a lot of information online, but sifting through it and tailoring it for your particular needs may be challenging without some support.

Conclusions

Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.

Virtual Reality applications for integrated cognitive and motor stroke rehabilitation show promise for providing more comprehensive rehabilitation programs. However, we are still missing evidence on its impact in comparison with standard rehabilitation, particularly in patients with cognitive impairment. Additionally, little is known on how specific stimuli in the virtual environment affect task performance and its consequence on recovery. Here we investigate the impact in stroke recovery of a virtual cognitive-motor task customized with positive stimuli, in comparison to standard rehabilitation. The positive stimuli were images based on individual preferences, and self-selected music (half of the sessions). 13 participants in the subacute stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Motor and cognitive outcomes were assessed at end of treatment (4-6 weeks) and at a 4-week followup. Both groups showed significant improvements over time in functional ability during task performance, but without changes in motor impairment. Cognitive outcomes were modest in both groups. For participants in the VR group, the score in the task was significantly higher in sessions with music. There were no statistical differences between groups at end of treatment and follow-up. The impact of VR therapy was lower than in similar studies with stroke patients without cognitive deficits. This study is a first step towards understanding how VR could be shaped to address the particular needs of this population.